Seyran Bozkurt

Impact of Ramadan on demographics and frequencies of disease‐related visits in the emergency department

The objective of this study was to determine whether Ramadan is changing frequencies and demographics of visits due to certain diseases. Data obtained from the charts of the adult patients admitted into the emergency department (ED) due to 10 predetermined entities between 2000 and 2004 were analysed. Demographic variables analysed separately for certain entities visiting the ED in Ramadan were not found to be different from visits in other times of year. Visit frequencies for hypertension and uncomplicated headache in Ramadan were significantly higher than in non‐Ramadan months (χ2 test, p = 0.015 for hypertension, p < 0.001 for uncomplicated headache). Mean age of the patients admitted to the ED due to diabetes‐related conditions in Ramadan was significantly lower than in pre‐ and post‐Ramadan months (59.91 ± 14.60 and 62.11 ± 14.61, respectively) (Mann–Whitney U‐test, p = 0.032). The patients with diabetes presenting in Ramadan were found significantly younger than their peers in the rest of the year. For other diseases, Ramadan does not appear to be a risk factor.

Lingual angioedema after alteplase treatment in a patient with acute ischemic stroke.

BACKGROUND In recent years, thrombolytic therapy has become the main treatment of ischemic stroke. But the increasing use of alteplase in ischemic stroke has made some complications more evident. Angioedema is a rare but potentially life-threatening complication of alteplase treatment. Only a few studies have examined the incidence of angioedema after treatment with alteplase for stroke. METHODS A 75-year-old man complaining of right hemiparesis was admitted to our emergency department. He was diagnosed as having acute ischemic stroke, and alteplase infusion was given two hours after the onset of stroke symptoms. Immediately after the completion of infusion he was noted to have a large swollen tongue. RESULTS His neurological symptoms resolved gradually within 4 hours, whereas his upper extremity strength improved to 4/5 and lower extremity 5/5. Lingual edema resolved within 16 hours without any complication. He died from presumed nosocomial infection 5 days later. CONCLUSIONS Lingual angioedema may appear as a possible complication in patients who were treated with alteplase. The management of these patients should be very careful.

Factors Affecting Burnout and Job Satisfaction in Turkish Emergency Medicine Residents

Objective: Despite the increasing concerns on burnout and job satisfaction in health-care professional, very few studies have examined resident physicians in Turkey. This study was aimed to determine the factors affecting burnout and job satisfaction among emergency medicine residents in Turkey. Method: An number of 410 emergency medicine residents including e-mail addresses registered to Emergency Medicine Associations received questionnaire forms previously prepared on an internet-based questionnaire site. Participants were asked to fill out Maslach Burnout Inventory (MBI), Job Satisfaction Scale (JSS) and socio-demographic data form. Results: Decrease in depersonalization grades and increase in personal accomplishment grades with the advancing age were found. Residents who had an experience greater than 10 years in the profession showed lower depersonalization grades in comparison with the beginners. Residents who could not reach a consultant for patient evaluation presented higher emotional exhaustion grades. Also residents who felt appreciated in work place and work in concert with the staff had lower burnout grades and higher job satisfaction grades. An increase in the average number of patients seen per day was found out to boost emotional exhaustion grades. Also the visible increase in the time spent for social activities during the week reduced emotional exhaustion and depersonalization grades while increasing personal accomplishment grades. Residents who were exposed to daily violence had lower job satisfaction grades and higher emotional exhaustion and depersonalization grades than those experienced violence on a monthly basis. Increase of job satisfaction was accompanied by a decreased burnout level. Conclusion: Emergency medicine residents have high burnout levels. For diminished burnout level and enhancement of job satisfaction in emergency medicine, adjustments like social support, workload, workplace stress and prevention of violence would be useful.

A case of headache, double vision and ptosis in emergency department: Tolosa-Hunt syndrome

Headache and double vision symptoms can be seen especially neurological and optical problems. We present Tolosa-Hunt syndrome in a 34-year-old female patient who presented to the emergency department (ED) with the complaints of unilateral severe headache, double vision and ptosis, presented asymmetric contrast enhancement in the right superior cavernous sinus on MR. This pain was reduced with steroid therapy. Pulse steroid therapy of 1 mg/kg/day was planned based on the patients clinical manifestation, MRI findings and presumed diagnosis of THS. It was observed at patients follow-up that there were occasional headache, ptosis and double vision were disappeared and MRI findings were regressed. In the differential diagnosis of patients presenting to the ED with the complaints of headache and double vision, rare pathologies such as THS should be considered in addition of common pathologies such as neurological and ocular diseases.

Severe shoulder pain: calcifying tendinitis of the subscapularis tendon

Sayın Editör, Kalsifik tendinitler ortopedi polikliniklerinde çok yaygın görülmekle birlikte, acil servise omuz ağrısı ile başvuran hastalarda nadiren gelen veya acilde çalışan hekimler tarafından unutulan bir tanı olarak görülmektedir. Bu çalışmada, acil servise şiddetli omuz ağrısı ile başvuran ve tüm aciller ekarte edildikten sonra kalsifik tendinit tanısı konulan bir olguyu paylaşmak istiyoruz.

A Rare Cause of Sudden Ptosis: Posterior Communicating Artery Aneurysm

SUMMARY A forty-seven-year-old female patient was admitted to our clinic with sudden ptosis and diplopia without pain. She had no trauma or systemic disease history. Ptosis and mydriasis were observed in her left eye. Eye movement was restricted all directions without lateral. Isolated oculomotor nerve paralysis was diagnosed based on clinical findings, and posterior communicating artery aneurysm was observed in magnetic resonance angiography.

Retrospective analysis of whole-body multislice computed tomography findings taken in trauma patients.

Objectives Using whole-body multislice computed tomography (MSCT) excessively or with irrelevant indications can be seen in many centers. The aim of this study was to analyze retrospectively the MSCT findings in trauma patients admitted to the emergency department. Methods Records of the patients who have applied to the emergency department due to blunt trauma in a 12 month period and whose whole body MSCT images have been taken, were evaluated using the “Nucleus Medical Information System”. Results The most frequent type of trauma was traffic accidents in 61.4%, falling down from the height in 22.4%, and motorcycle accidents in 11.4% of patients. Of the patients, 25.2% were discharged from the emergency, while 73.8% were hospitalized. At least one CT findings associated with trauma was present in 61.4% of our patients. Pathological findings in MSCT were most frequently detected in the head and face (35.3%) and thoracic (28.6%) regions, respectively. The most common finding in the head and face region was fractures. The most common pathological findings in the thoracic region were pulmonary contusion and rib fractures. A significant relationship was detected between trauma type and spinal MSCT result (p < 0.001). In a large percentage of the patients, MSCT findings were normal in the abdominal region and genitourinary system. Vertebral fractures were most frequently detected in the thoracolumbar region. Conclusions In our study, our rate of negative CT was found to be 38.6%, which is a higher ratio compared to other studies conducte on this topic.